A systematic review and meta-analysis on the impact of nail length in treating intertrochanteric fractures

Abstract

The management of intertrochanteric hip fractures remains a subject of ongoing debate, particularly regarding the ideal nail length for treatment. To address this, a systematic review and meta-analysis, based on randomized controlled trials (RCTs), were conducted to assess the outcomes associated with using short and long nails to fix intertrochanteric femur fractures. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines for comprehensive reporting, a thorough search was conducted across four databases (Cochrane, Google Scholar, Web of Science, and PubMed) from inception until March 07, 2022. The study encompassed all RCTs comparing the outcomes of short and long nail fixation for intertrochanteric hip fractures. A total of 620 patients with intertrochanteric fractures from six RCTs were included in this analysis. Short nails were used in 50.3% of the patients (312 out of 620). The utilization of short nails was significantly associated with a reduction in operative time (weighted mean difference [WMD] = −20.33; 95% confidence interval [CI]: −29.90–−10.76) and decreased blood loss (WMD = −106.31; 95% CI: −155.43–−57.19). However, no substantial differences were observed between the two types of implants in terms of length of hospital stay, Harris hip score, reoperation rate, complication rate, and 1-year mortality rate. The length of nails used to treat intertrochanteric hip fractures does not have a notable impact on factors such as functional recovery, blood transfusion frequency, reoperation likelihood, complications, or 1-year mortality rates. Nonetheless, when comparing the fixation of intertrochanteric fractures, it is worth noting that short nails result in shorter surgery duration and reduced blood loss compared to long nails.